HEAVY LIFT CHAMPIONSHIP

(USAWA Membership Required of all Contestants)

PROMOTER:Eric Todd

DATE:May 5, 2018

TIME:10:30AM

LOCATION:ET’s House of Iron and Stone

WEIGH-INS:9:30 AM
RULES:10:00

EVENTS:Neck lift

Hand and Thigh

Hip Lift

ENTRY FEES:$25

ENTRY DEADLINE:April 21, 2018

MAKE ALL CHECKS PAYABLE TO:Eric Todd

10978 SW Pueblo Dr

Turney, MO 64493 (Entries received are non-refundable)

Email:

ENTRY FORM

In consideration of your acceptance of this entry, I hereby, for myself, my heirs, executors and administrators, and my assignees, waive and release all rights and damages I may have against The Heavy Lift Championship, Eric Todd, USAWA,, any and all sponsors of the event, their representatives and assigns, for any and all injuries incurred by me in conjunction with these championships and in traveling to and from the event. And in further consideration of permission being granted to me to participate in the 2018Heavy Lift championship and its related events, I hereby grant USAWA., and/or any other approved video or entertainment organization and all of their agents, successors, licensees and assigns, the right to photograph or otherwise reproduce (whether by film, tape, still photography or otherwise) my voice, appearance and name, and to exhibit, distribute, transmit, and/or otherwise exploit any and all media, including without limitation, by means of still photography, motion pictures, radio, television, television motion pictures, video, printing or any other medium now known or hereafter devised, including with respect also to any merchandising, advertising and/or publicity, and the right to use my name and information about me in any connection with any of the foregoing. The rights granted by me hereunder are granted for the entire universe and shall endure in perpetuity and no further compensation shall be payable to me at anytime in connection therewith. Nothing contained herein shall be deemed to USAWA, and/or any other approved video or entertainment organization, to photograph or otherwise reproduce my voice, appearance or name, or to make use of any rights granted herein. I also understand that the aforementioned rights may be reassigned at any time without further consent. I understand that USAWA. and/or any other approved video or entertainment organization, are videotaping and photographing the Event in express reliance upon the foregoing, and I represent and agree that I am free to grant the rights granted to USAWA. and/or any other approved video or entertainment organization hereunder. Therefore I affix my signature below:

NAME:AGE:

ADDRESS:

CITY:STATE:ZIP

PHONE:DATE OF BIRTH:

Email______

SIGNATURE:

(PARENT OR GUARDIAN SIGNATURE REQUIRED IF CONTESTANT IS UNDER 18 YEARS OF AGE)